Permit /r/i �r �{�/>7 r ^ / / Cl / ! Y (e Le 'v
CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: ELC2011 00046
Tj p 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 01/20/2011
Parcel: 1S134BC00401
Jurisdiction: Tigard
Site address: 12442 SW SCHOLLS FERRY RD 202
Project: Scholls Ferry Rehab Subdivision: Lot: 0
Project Description: Phase 2: (8) branch circuits. 2/18/11, reprinted permit to include (1) low voltage fire alarm system. BT.
Contractor: COCHRAN INC Owner: PROVIDENCE HEALTH SYSTEM
7550 SW TECH CENTER DR. #220 4400 NE HALSEY BLDG 1 SUITE 160
TIGARD, OR 97223 PORTLAND, OR 97213
PHONE: 503 - 215 -6282
HONE: 503 - 234 -6564
FAX: 503 - 238 -2098
FEES
Quantity Description Date Amount
8 crt Branch Circuits wo /Purchase 01/20/2011 $108.12
Specifics: Service or Feeder
1 ea 12% State Surcharge - 01/20/2011 $12.97
Type of Use: COM Electrical
Class of Work: ALT 1 ea Limited Energy 02/18/2011 $75.00
Type of Const: 9 12% State Surcharge - 02/18/2011 $9.00
Electrical
Occupancy Grp:
Total $205.09
Required Items and Reports (Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180
days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952 - 001 -0010 through • : — 52- 001 -0090. You may obt'n - • • o' t e les or direct questions to OUNC by calling 503.232.1987 or 1.800.332,2344.
_... _
Issued By: - - .G"' Permittee Signature: AP
OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale, lease or rent.
OWNER'S SIGNATURE Date:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC' Date:
LICENSE NO.
Call 503.639.4175 by 7:00 a.m. for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
CITY OF TIGARD ELECTRICAL PERMIT
e 2 z" COMMUNITY DEVELOPMENT Permit #: ELC2011 -00046
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 01/20/2011
Parcel: 1S134BC00401
Jurisdiction: Tigard
Site address: 12442 SW SCHOLLS FERRY RD 202
Project: Scholls Ferry Rehab Subdivision: Lot: 0
Project Description: Phase 2: (8) branch circuits
Contractor: COCHRAN INC Owner: PROVIDENCE HEALTH SYSTEM
7550 SW TECH CENTER DR. #220 4400 NE HALSEY BLDG 1 SUITE 160
TIGARD, OR 97223 PORTLAND, OR 97213
PHONE: 503 - 234 -6564
PHONE: 503 - 215 -6282
FAX: 503 - 238 -2098
FEES
Quantity Description Date Amount
8 crt Branch Circuits wo /Purchase 01/20/2011 $108.12
Specifics: Service or Feeder
1 ea 12% State Surcharge - 01/20/2011 $12.97
Type of Use: COM Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $121.09
Required Items and Reports (Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180
days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952- 001 -0010 through 0 952- 001 -0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.32.1987 or 1.800.332.2344.
Issued By: \ _ � ' - Permittee Signature: ® 9
OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale, lease or rent.
OWNER'S SIGNATURE Date:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC' Date:
LICENSE NO.
Call 503.639.4175 by 7:00 a.m. for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
01
E �g 08:48:26 01 -20 -2011 1!2
F 1 J
Electrical Permit Applicatio t � � t. k-. FOR OFFICE USE ONLY
City of Tigard JAN 2 0 2011 Received
N 13125 SW Ball Blvd. Tigard, OR 97223 Date'B : /r °'`d L(��' *,1 Permit No �' oDO�
f
Date /B n
Other Pcn je�0�0 (9O � 5
111 11
Phone: 503.639.4171 Fax: 50 3 . 598 . Ir96 0�/ OF I IG�t. y ✓_
TIGARD Inspection Line: 503.639.4175 • v 1 �? Date Ready /By: .runs. El See Pa e 2 for
Internet: www.tigauet or.gov BUILDING DIVISION' Notified /Method: ' Tie" ' Supplemental Information
• TYPE OF WORK SS" • PLAN• REVIEW .
❑ New construction LSAddition /aIteration /replacement Please check all that apply (submit 2 sets of plans w /items checked below):
1 ❑ Service or feeder 400 amps or more ❑ Building over three stories.
❑ Demolition ❑ Other: where the available fault current ❑ Marinas and boatyards.
'.'CATEGORY OF CONSTRUCTION '' . exceeds 10,000 amps at 150 volts or ❑ Floating buildings,
less to ground. or exceeds 14,000 ❑ Commercial -use agricultural
❑ 1- and 2- family dwelling "aCommercial /industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi- family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or
❑ Emergency system, larger separately derived system. r .
ry •
2 •' Ce .JOB SITE INFORMATION AND LOCATION . . ❑ Addition of new motor load of ❑"A" "E' I -2 ". ^ I -3'
Job no.: VX Job site address: ,21.- i_ >.3�2 5 11 ,..,k---,r � ' Z 0 Z 10011P or more, occupancy.
❑
1111 / /// 0 or more residential units. Recreational vehicle parks.
City /State /ZIP: ;; ek ` F—+ f o 1.'3 ❑ Health -care facilities. ❑ Supply voltage for more than
722 ❑ Hazardous locations. 600 volts nominal,
Suite/bldg. /apt. no.: c; 2_,
Prof Project name: V�� Cv�� ��C�h ['Service or feeder 600 mops or store.
\� -- • FEE SCHEDULE.
Cross street /directions to job site: •\1■cs s! Description Qty. f }'cc. 1 Total I "
New residential single- or multi - family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. II, or less 168.54 4
•
— Ea. add'I 500 sq. Ii. or portion 33.92 1
Tax map /parcel no.: • Limited energy, residential
• . DESCRIPTION O Fr WORK • ' (with above sq. 11.) 75.00 2
Limited energy, multi- lamily 75.00 \�2 3Cp e_ Gk�.� i f fa ` ?\i.e� Z residential (with above sq. ft.) 75. 2
Services or feeders installation, alteration, and /or relocation
200 amp's or less 100.70 2
' • 1 ❑ PROPERTY OWNER ' " / TENANT ' 201 amps to 400 amps 133.56 2
Name: ? --p� ', R 401 amps l0 600 amps 200.34 2
601 amps to 1,000 amps 301.04 2
Address: Over 1,000 amps or volts 552.26 2
City /State/ZIP: Temporary services or feeders installation, alteration, and /or_
relocation
Phone: ( ) Fax: ( ) 200 amps or less 59.36 1
201 amps to 400 amps 125.08 2
Owner installation: This installation is being made on property that I own which is not
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 168.54 2
Branch circuits - new, alteration, or extension, per panel
Owner signature: Date: A. Fee for branch circuits with
❑ APPLICANT CONTACT PERSON above service or feeder fee, 7.42 2
each branch circuit
Business name: 7V-Me. c C- . -L _ _ B. Fee for branch circuits without
�1 service or feeder fee, first ` � � ( Q 2
Contact name: branch circuit 56 ' 18 r�
Each add'I branch circuit -7 .7.42 e , Li 2
Address: _ Miscellaneous (service or feeder not included)
City /State /Z1P: Each manufactured or modular 67 84
dwelling, service and /or feeder
Phone: ( ) Fax: : ( ) Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
E -mail: _ _
Sign or outline lighting 67.84 2
CONTRACTOR, Signal circuit(s) or limited energy
Business name: �" k _panel, alteration, or extension. Page 2,_, 2
-^7 �, '� '' . � Each additional inspection over allowable in any of the above
Address: 1 5Q 6 (�In - o r �( ^ #22 a Additional inspection (I hr min) 66.25/ hr
Itrmin � Investigation I
City/state/z1P: � •- f �( (' OK I 72 g ( ) 6 6. 2 5/hr
�= Industrial plant (I hr min) 78.18/ hr
Phone: 503) 23q �Sjosf Fax: (V ? _ 2_0 Q s' /Inspections for which no fee is 90.00 / hr
1 L/ speci listed (Y: hr min)
1 CCB Lic.: •'72 7ciZ Electrical Lic.: 3 Suprv. Lie.: 3 . ' ELECTRICAL PERMIT FEES '
1
Suprv. Electrician signature, required: V \_ Subtotal: - t�j� 2—
/ ( Plan review (25% of permit fee):
K
Print name: P . —� Date: l {2.01 k,( State surcharge (12% of pencil fee): \ Z , c l 7
' \ l TOTAL PERMIT FEE: ' 21 l 09
Authorized signature:
• This permit application expires if a permit is not obtained eithin I80
Print name: Date: days after it has been accepted as complete.
w * Number of inspections allowed per permit.
It nui lding•Pcr,ni,s.LLC Pcn alit App doc slot'10 440.4015T(11gt5d'OM'WEB
01 16:23:13 02 -17 -2011 1 /3
Electrical Permit Applica J ryF �d +/ r ' ) FOR OFFICE USE ONLY
U U Lv . .` -L 1 t 1 m 1_ • Received
City g of Tigard Permit No.: t (,G rtO
Date/6 : II ) I't7 t i�P
III I 13125 SW Hall Blvd., Tigard, OR 9 3 1 7 q 2011 Plan Review
C Phone: 503.639.4171 Fax: 503,598.1960 Date /By: Other Permit:
Inspection Line: 503.639.4175 / r Date Ready /By: •turfs: El See Page 2 for
TIGARLI(
• Internet: www.tigard- or.gov CITY Or u rt Notified/Method: ?_f Supplemental Information
DI III f1It t•1llflt:lt'th!
K._..:1. ixi • - •- tT.•- ::: =N-i. e•::::. -.,. �Y'v. .. ta:1. - . ..:r :C:.� .. .. . • . - ?: .:�. � _ - _ - _ _
:,t <, }:i _ .... r...w'yrrri ?i�.ii" -: feti.�'•.'g r r', ? ., y :i •c..,�;F�:rt. W�'te i`fi;':i ?�::
. � ate -.1 a -•-r s.... ;i: i. ,,,.rfi ''. -+ a
..1 SS •.. '1 '1: ),.. 4 . :!' ,:. " T 4' . - , i: q , ,, • I • - ..,... -. ., iT -.,i�� h ..,:„.: ., � L, ,,,,, -,..
. _
a x <;� � wry, 1?E...O V4fO�t�C >:: -:r., r .�;..�.., �u:. w , ; . ::��.�.31'��l•�I�:��+ `�+��/ .�'��s•�a,��:...,.;,,,;�
,..3.. �..�$:v:..,yE �.,.. �4,.. . a«•..1,! 1 xr,�! l ,l`..� .� -1 : 7.t[ ; , y ) f ,'C i_ ?i.� :. 4 T : ..7 Y...,_�•9 e:�<::+:t- '.•_`.. . .. yC'x ��+Vt °. ,
❑ New construction Addition /alteration /replacement Please check all that apply (submit 2 sets of plans w /items checked below).
❑ Service or feeder 400 amps or more ❑ Building over three stories.
❑ Demolition ❑ Other: where the available fault current ❑ Marinas and boatyards.
;;ilc; i?'N .. ,;,f +::;:i;°i... ^, ,...t.r :n- .,.,v ,_, , :;: - - "'"s.'- ;p,:;n.:x t•-.:::i' %.4:0 . :a'; r exceeds 10 000 amps at 150 volts or
r` -- N' . '... ,,u6:t>„ � CST`. �dRY: -- CON " -„� .y; ? :. . r ll:,i: P ❑ Floating Commercial a
•` Yn:x �....... ... 5 _( LC;L'��r'•q,;G4c- 1i • WN. 7t..:. t:... t..:� ..5 1::i':Y:45:7;6.xSlAi -f�: _Y... ^•Y:.d ^.�', ^ni1�I�.111.7 :�tCt'F;'w _
less to ground, or exceeds 14,000 ❑ Commercial - use agricultural
❑ 1- and 2- family dwelling .Commercial /industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi- family ❑ Master builder ❑ Other: ❑ Fire pump. 0 installation 0f75 KVA or
.c:.::. , r,j1;, �r -. __- ,%its: . >•-- :.:_'�' == 5 *`` =: •: ::L,m.��::: ,. ❑ Emer�ene system'
larger separately derived system.
.
:;1,IV:- 5;;.,x- , °JOB ;.,. :iNFOOiM f O . 'Al D L`Ot0A'FI 11 -� 1:-.IF .. •,
.. _ .- s: >s<;iici:r5...`s::. , . ,,_�,..tt �..�, ;,,P..��. ,:,� �.,,r::�W.. - <.,:,.: -.:- -.,.. ;,v. - = .%c:a.., �.g, ❑ Addition of new motor load of 0"A-, ,,E,. - n", .,1-
1 ",
Job no.: t P�Z33G Job site address: Iz4u �5W Sc.�Ab( IOOHPormore. occupancy,
1 S ❑ S ix or more residential units. ❑ Recreational vehicle parks.
City / State/ZIP: I l O O R c `-7 Z'2- 3 ❑ Health -care facilities. ❑ Supply voltage for more than
�
cam. "1 7 ❑ Hazardous locations. 600 volts nominal.
Suitclbldg. /apt. no.: Project name: pp ❑ Serviceorfeeder600ainpsornrore.
(_O - J P'('D V I Uletnc- C.l1Lt L r�•s_t
nt isr,' i � : ;k , t' ' � tf^' " s>k E
C E ` .GH r.? aw =i tike, - , Iw tt: v
Cross street/directions to job site: �D Uun ., .La- .e,fi:_..�.._. v . I e • [ ;
P ee. _ 'k Total t:i' :
P I Qty- I F ee ,: s 1 To ta � _
New residential single- or multi - family dwelling unit.
Includes attached garage.
1 ,000 sq. I1. or less 1 68.54 4
Subdivision: Lot no.:
Tax map /parcel no.: Ea. add'I 500 sq. 0• or portion 33.92 1
Limited energy, residential
n _!d'w�: , i •ir�•�U;',Cyt%, -n.,�w •s.a i ;.f: , :,u - a; ^':s::. �.;,,..� ,-;j';.c` '•�..t':iz;: 75.00 2
,
l3�w�t}��.`';t,��5!� r:�:��3•,; r'* . �.D G • -OR,: � .r „. •� �` °s; - •;ii (with above sq. ft.)-
_. 1- �,�.,..:r.' , � � �n• � rt: �•% � r.fh�w'�- �wii;=;;';::�,':s "_r.
-Qp Limited energy, multi family
�CIC/L- 140r Vl - e o r vk 5 f•-t�o eve.- - SSMO f te, - CoY` residential (with above sq. ft.) 75.00 2
l Services or feeders installation, alteration, and /or relocation
n e vlJ T 2 .. (`C u b r rn [ 8 /,(�JJ /- y'_ 200 amps or less 100.70 2
: -sl•:, ,�� � v t :,.:...r.,:,,,:,,::r -..: �':m - �-� t : - tr z: t • °��,a. aK It w t 201 40 amps 13356 2
i:.
_,3.x 'O''''j I� " i' f v ` ` 5 40 ,• i -.' ;VI I t �,, t 1 . . a: ± ,y : -,.dl5 amps am .
; ;A:.-Pr.!h .r .. ,,,.1!S`4.p lt0 , .f ,, j}t. �L,ni T M I4n; ru t.• ,�h �:,. -,= ` aL `?Y: ._ P P
- 7. . _ ,.. �.:. -.... ,n. >. `L � .�rrSl'.'�E:'.!?i�}... :., = _,.:+h ., „��HErf:k;£. +:- 5� -�
Name:
401 amps to 600 amps 200.34 2
601 amps to 1,000 amps 301.04 2
Address: Over 1,000 amps or volts 552.26 2
Temporary services or feeders installation, alteration, and /or
City / State/ZIP:
relocation
Phone: ( ) Fax: ( ) 200 amps or les 59.36 l
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 125.08 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 168.54 2
Branch circuits - new, alteration, or extension, per panel
Owner signature: Date: A. Fee for branch circuits with
_'.- "t.. c r..c. >: -t» ,, .., w , .. .,; ., t ^ - _ , r rz, n ; ok , ..n.�y r ^.";
' :- a {s _ ,.., } 1^f 3 Y x;15 ..` O _ i a ,a a v T, s•• .T . Sr7b , rt(.� above service or feeder fee
r PPLfG'rf!17 .t G ., , R$O - 7.42
,, ...- .._�.. -_...: .. �.,.• �< �:.-;-.•.,,,::: :•,:?�- :F,F.�z:,.,�s-= x,.�: +1 1,�W. -r. a---0.(-- ,> _ ,,, ,;, ,,,��4;�:c�� each branch circuit 2
Business name: 5a`` Q .S Co -k t B. Fee for branch circuits wilhou!
• ``+ service or feeder fee, first 56.18 2
Contact name: branch circuit
Each add'I branch circuit 7.42 2
Address: Miscellaneous (service or feeder not included)
Each manufactured or modular
City / State/ZIP: dwelling, service and/or feeder 67.84 2
Phone: ( ) Fax: : ( )
Reconnect only 67.8 z
Pump or irrigation circle 67.84 2
E -mail:
:x'Sax :u• ,; a,:,,. i - rie- ,;,:. _ _s':a; rr;:, y.+ Sign or outline lighting 67.84 2
's4 .. _ ;'ids �< ,;:I s` T d - T ; - ;f;" -:: N ..; s. :�u :'•:<
.. � ,,, �: �r..';* �:: �;: � �;.` s.. A. �-. k� �•<..,,. i,.,., �-. �Cp, ��, C„ �. O. R° ��, 9i-. r�,:!,' x,! ��s. 5sr�. r,,,. t: .� ;.c: a= �;~`? - Signal circa it (s)orlimitcd•cncrgy ex Business name: C�h c 1,� panel, alteration, or extension. Page 2 -7 _ 2
i _ C Each add itional inspection over allowable to any of the above
Address: 1 5 50 u ,N (�h ( � ' I p ( � #2 2 0 Additional inspection ( hr min) 66.25/ hr
` Q � \ T v o r^ Investigation (1 hr min) 66.25/ hr
(t �j
City /State/ZIP: a . (• 72 2. Industrial plant (I hr min) 78.18 / hr
Phone: 503 ) Z3q L 5(0(7/ Fax: (j3 )23g Zd a $' Inspections for which no fee is 90.00 / hr
specifically listed CA hr min)
CCB Lie.: E l ectrica l Lie .: �75L/ Su rv. Lie.: i4 5 ".-, `. _..
�7Z. ��fZ. p 3�( �_ _�'° ti�.. �.:,,:: �,° �> ��ri�t:! �> ��> �: �?aT Mr.S:n:T,;:..,Y_s•`:rv;
l � .. ` • _ Subtotal.� `��
Suprv. Electrician signature, required: Plan review (25 % of permit fee):
Print name: �[ �1r1� k Date: `A )_ (i a ‘ State surcharge (l2% of pennit fee): q
' \ TOTAL PERMIT FEE: '3lf , (9°
Authorized signature: This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Print name: Date: • Number of inspections allowed per pennit.
1:• Building lPcnnits'ELC Permit App.doc 07 440- 4615T(I1,05.COM•WEB
01 16:23:55 02 -17 -2011 2/3
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
N � .. .,�_ t ` k, k "t t. ��"e -x�_: -ails; �,2' u'}; -.'''t ,s .rn if.�,� �.f.' :� = r�� =ti
i
xis rIAI: Wo o i ;
Fee for all residential systems combined $75.00
Check Type of Work Involved:
❑ Audio and Stereo Systems*
E Burglar Alarm
❑ Garage Door Opener
❑ Heating, Ventilation and Air Conditioning System*
❑ Vacuum Systems'
❑ Other:
"Minet.OWNORCONtiniERSRON..
Fee for each commercial $75.00
system
(SEE OAR 918 - 309 -0000)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
❑ Data Telecommunication Installation
j X,1 Fire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
I: Building \Pennits'ELC- PcrmilApp.doc 07,0{il0